Heart failure (HF) is the fastest growing cardiovascular disorder in the U.S., and ventricular assist device (VAD) therapy is emerging as a main therapeutic option for advanced HF. Because outpatient care of a VAD patient is critical to the success of this high-risk therapy, current guidelines require that VAD patients designate an informal caregiver. At the same time, broad consensus in the literature that associates caregiving with compromised health and quality of life (QOL) suggests that VAD caregivers are also an at-risk population. Together, mandated patient-caregiver dyads play a critical role in VAD therapy, but without knowledge of the impact of VAD therapy on the dyad, providers are limited in their ability to identify and support patients and caregivers at greater risk for poor outcomes. As such, the overall goal of this proposed research is to provide much-needed quantitative data on VAD patient-caregiver dyads, describing changes in and identifying determinants of patient, caregiver, and dyadic outcomes over time. A prospective longitudinal cohort study, ancillary to a NINR-sponsored R01 on VAD patients, will be conducted to collect data on associated caregivers of patients enrolled in the parent study. Using a dyadic approach, multilevel and multivariate longitudinal modeling will be used to: 1) identify individual-level (patient and caregiver) determinants of worse patient clinical event risk and QOL, 2) quantify the relationship between individual-level determinants of worse caregiver strain and physical health, and 3) describe change in psychological symptoms and QOL in VAD patient-caregiver dyads over time. This innovative research will be the first longitudinal, quantitative study of patient-caregiver dyads in VAD, and will therefore provide foundational data to advance clinical management and research, and better support optimal patient, caregiver, and dyadic outcomes. Additionally, as part of a National Research Service Award proposal, this study contributes to the long-term goal of developing the applicant into an independent and productive nurse-scientist with a sustainable program of research that develops clinically relevant, actionable knowledge to address critical concepts and issues in the management and support of this rapidly growing, at-risk population of VAD patients and their caregivers. In order to ensure that the applicant has the necessary knowledge and expertise to attain this goal, this proposal draws on the combined expertise of an exemplary interdisciplinary team, consisting of expert clinicians and researchers in HF, VAD, and caregiving dyads, who have, in collaboration with the applicant, developed a comprehensive training plan that includes essential mastery of content and applied experience in the ethical conduct of research, multiple analytic approaches, and scholarly dissemination. The fundamental outcomes of this proposal are therefore well-aligned with the goals of the NINR, in that it will support the development the next generation of nurse scientists and enhance innovation, while concurrently providing information to promote health, improve QOL, and reduce symptoms in a growing and vulnerable population of patients and caregivers.